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Glomerulonephritis is a histopathologic diagnosis acutely associated with clinical findings of hematuria, edema, and hypertension. It commonly follows a pharyngitis caused by group A β-hemolytic Streptococcus in children between 3 and 7 years of age. Patients < 2 years are rarely affected. Timely treatment of pharyngitis does not clearly decrease the incidence of acute glomerulonephritis.

Diagnostic Findings

There is usually a preceding streptococcal infection or exposure 1 to 2 weeks before the onset of glomerulonephritis. An interval of less than 4 days may imply that the illness is an exacerbation of preexisting disease rather than an initial attack. Fever, malaise, abdominal pain, and decreased urine output are often noted.

The physical findings reflect the duration of illness. Initial findings may be mild facial or extremity edema only, with a minimal rise in blood pressure. Patients uniformly develop fluid retention and edema and commonly have hematuria (90%), hypertension (60%–70%), and oliguria (80%). Fever, malaise, and abdominal pain are frequently reported. Anuria and renal failure occur in 2% of children. Circulatory congestion, as well as hypertensive encephalopathy, may be noted.

Ancillary Data

Urinalysis reveals microscopic or gross hematuria. Erythrocyte casts are present in 60% to 85% of hospitalized children. Proteinuria is generally less than 2 g/m2 per 24 hours. Hematuria (Fig. 84–1) and proteinuria (Fig. 84–2) may present independently and require a specific evaluation.2 Leukocyturia and hyaline and granular casts are common.